UnitedHealth Group

UnitedHealth Group is a diversified health care company with two distinct platforms, UnitedHealthcare for health benefits and Optum for health services, serving more than 100 million people worldwide. The company offers FHIR R4-compliant Interoperability APIs through the Optum platform, providing patient access to health records, claims history, provider directory, and drug formulary data in compliance with CMS Interoperability and Patient Access final rule (CMS-9115-F) and HL7 FHIR standards.

UnitedHealth Group publishes 4 APIs on the APIs.io network, including Clinical Data API, Drug Formulary API, Patient Access API, and 1 more. Tagged areas include Healthcare, Health Insurance, FHIR, Claims, and Interoperability.

The UnitedHealth Group catalog on APIs.io includes 1 JSON-LD context and 2 Spectral governance rulesets.

UnitedHealth Group’s developer surface includes authentication and 4 more developer resources.

🌐 Visit website 📡 Source on GitHub

42.1/100 developing ▬ flat Agent 31/100 agent aware Full breakdown ↓
scored 2026-07-28 · rubric v0.6

AccessEnterpriseSelf serve

4 APIs

HealthcareHealth InsuranceFHIRClaimsInteroperabilityFortune 100

Kin Score

Kin Score How this is scored →
scored 2026-07-28 · rubric v0.6

Composite quality — 42.1/100 · developing

Contract Quality 18.3 / 25

Developer Ergonomics 2.2 / 20

Commercial Clarity 5.8 / 20

Operational Transparency 2.7 / 13

Governance 7.0 / 12

Discoverability 7.4 / 10

Agent readiness — 31/100 · agent aware

Machine-Readable Contract 18 / 18

Agentic Access Contract 10 / 10

MCP Server 0 / 12

Machine-Readable Auth 10 / 10

Idempotency 0 / 9

Stable Error Semantics 0 / 8

Request/Response Examples 0 / 7

Rate-Limit Signaling 7 / 7

Typed Event Surface 0 / 6

Agent Skills 0 / 5

Well-Known Catalog 0 / 4

Consent & Bot Identity 0 / 3

A2A Agent Card 0 / 8

Dry-Run / Simulate Mode 0 / 4

Improve this rating by publishing the missing artifacts — every area above can be raised, and the full rubric is at apis.io/rating/. This rating is computed from github.com/api-evangelist/unitedhealth: open an issue to ask a question, or submit a pull request to add artifacts. Want it done for you? Prioritized profiling — $2,500 →

APIs 4

Individual APIs this provider publishes, each with its own machine-readable definition.

GraphQL 1

GraphQL schemas published by this provider.

Rate Limits 1

Documented rate limits and quota policies.

Unitedhealth Rate Limits

2 limits

RATE LIMITS

FinOps 1

Cost, billing, and metering signals for API financial operations.

JSON Schema 6

Standalone JSON Schema definitions for this provider's data models.

Examples 5

Example request and response payloads for these APIs.

AGENTIC

Resources

Agent Surfaces 1

MCP servers, agent skills, and machine-readable catalogs

AgenticAccess

AgenticAccess

Access & Security 3

Authentication, authorization, and security posture

VulnerabilityDisclosure

VulnerabilityDisclosure

DomainSecurity

DomainSecurity

Authentication

Authentication

Company 1

The organization behind the API

LinkedIn

Source (apis.yml)

aid: unitedhealth
url: https://raw.githubusercontent.com/api-evangelist/unitedhealth/refs/heads/main/apis.yml
name: UnitedHealth Group
description: UnitedHealth Group is a diversified health care company with two distinct platforms, UnitedHealthcare for health
  benefits and Optum for health services, serving more than 100 million people worldwide. The company offers FHIR R4-compliant
  Interoperability APIs through the Optum platform, providing patient access to health records, claims history, provider directory,
  and drug formulary data in compliance with CMS Interoperability and Patient Access final rule (CMS-9115-F) and HL7 FHIR
  standards.
tags:
- Healthcare
- Health Insurance
- FHIR
- Claims
- Interoperability
- Fortune 100
kind: company
accessModel:
  pricing: enterprise
  onboarding: self-serve
  trial: false
  try_now: false
  public: false
  label: Enterprise · Self-serve signup
  confidence: high
  source:
  - plans
  - authentication
  generated: '2026-07-22'
  method: derived
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/icons/unitedhealth.png
access: 3rd-Party
created: '2026-03-21'
modified: '2026-05-19'
position: Consuming
specificationVersion: '0.19'
common:
- type: AgenticAccess
  url: agentic-access/unitedhealth-agentic-access.yml
- type: VulnerabilityDisclosure
  url: security/unitedhealth-vulnerability-disclosure.yml
- type: DomainSecurity
  url: security/unitedhealth-domain-security.yml
- type: Authentication
  url: authentication/unitedhealth-authentication.yml
- type: LinkedIn
  url: https://www.linkedin.com/company/unitedhealth-group
apis:
- aid: unitedhealth:unitedhealth-clinical-data-api
  name: UnitedHealth Group Clinical Data API
  description: FHIR R4 clinical data including conditions, observations, and medications
  humanURL: https://www.uhc.com/legal/interoperability-apis
  baseURL: https://api.uhc.com/fhir/R4
  tags:
  - Clinical Data
  properties:
  - type: OpenAPI
    url: openapi/unitedhealth-clinical-data-api-openapi.yml
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/optum-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/optum-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealth-optum-api-context.jsonld
  - type: Examples
    url: examples/optum-fhir-patient-example.json
  - type: GraphQL
    url: graphql/unitedhealth-graphql.md
- aid: unitedhealth:unitedhealth-drug-formulary-api
  name: UnitedHealth Group Drug Formulary API
  description: FHIR R4 Drug Formulary API for prescription drug coverage information
  humanURL: https://www.uhc.com/legal/interoperability-apis
  baseURL: https://api.uhc.com/fhir/R4
  tags:
  - Drug Formulary
  properties:
  - type: OpenAPI
    url: openapi/unitedhealth-drug-formulary-api-openapi.yml
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/optum-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/optum-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealth-optum-api-context.jsonld
  - type: Examples
    url: examples/optum-fhir-patient-example.json
  - type: GraphQL
    url: graphql/unitedhealth-graphql.md
- aid: unitedhealth:unitedhealth-patient-access-api
  name: UnitedHealth Group Patient Access API
  description: FHIR R4 Patient Access API for member health data (CMS-9115-F)
  humanURL: https://www.uhc.com/legal/interoperability-apis
  baseURL: https://api.uhc.com/fhir/R4
  tags:
  - Patient Access
  properties:
  - type: OpenAPI
    url: openapi/unitedhealth-patient-access-api-openapi.yml
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/optum-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/optum-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealth-optum-api-context.jsonld
  - type: Examples
    url: examples/optum-fhir-patient-example.json
  - type: GraphQL
    url: graphql/unitedhealth-graphql.md
- aid: unitedhealth:unitedhealth-provider-directory-api
  name: UnitedHealth Group Provider Directory API
  description: FHIR R4 Provider Directory API implementing Da Vinci PDex Plan Net IG
  humanURL: https://www.uhc.com/legal/interoperability-apis
  baseURL: https://api.uhc.com/fhir/R4
  tags:
  - Provider Directory
  properties:
  - type: OpenAPI
    url: openapi/unitedhealth-provider-directory-api-openapi.yml
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/optum-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/optum-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealth-optum-api-context.jsonld
  - type: Examples
    url: examples/optum-fhir-patient-example.json
  - type: GraphQL
    url: graphql/unitedhealth-graphql.md
features:
- name: FHIR R4 Patient Access API
  description: CMS-mandated FHIR R4 Patient Access API providing members and third-party applications with access to claims,
    EOBs, coverage details, and clinical data.
- name: Provider Directory API
  description: FHIR R4 Provider Directory implementing Da Vinci PDex Plan Net IG for searching UnitedHealth Group network
    practitioners and organizations.
- name: Drug Formulary API
  description: FHIR R4 Drug Formulary API implementing Da Vinci Drug Formulary IG for accessing prescription drug coverage
    tiers, prior auth requirements, and quantity limits.
- name: Claims History Access
  description: FHIR ExplanationOfBenefit resources providing comprehensive claims history including service details, diagnosis
    codes, and payment adjudication.
- name: Clinical Data Exchange
  description: FHIR Condition and clinical data resources for member health history as reflected in claims and available clinical
    records.
- name: Coverage Information
  description: FHIR Coverage resources for current and historical insurance coverage details across UnitedHealthcare commercial,
    Medicare, and Medicaid plans.
useCases:
- name: Patient Portal Health Data
  description: Enable patient portals to display complete health records including claims, coverage, and conditions using
    FHIR Patient Access APIs.
- name: Care Coordination Apps
  description: Build care management tools that aggregate member health history, coverage, and clinical data for population
    health management.
- name: Provider Network Search
  description: Develop provider search applications using the FHIR Provider Directory to help members find in-network physicians
    and specialists.
- name: Prescription Benefit Transparency
  description: Integrate drug formulary data into clinical and patient-facing applications to show coverage tiers and prior
    authorization requirements.
- name: CMS Compliance Applications
  description: Build CMS-compliant third-party applications leveraging UnitedHealth Group's FHIR R4 interoperability infrastructure
    for data portability.
- name: Claims Analytics
  description: Access structured claims data as FHIR ExplanationOfBenefit resources for population health analytics and care
    gap identification.
integrations:
- name: Apple Health Records
  description: UnitedHealth Group FHIR Patient Access API integrates with Apple Health Records for member health data access
    on iOS devices.
- name: CommonWell Health Alliance
  description: UnitedHealth Group participates in CommonWell for FHIR-based health information exchange across provider networks.
- name: Carequality
  description: FHIR data exchange integration through Carequality framework for nationwide health information network connectivity.
- name: Da Vinci Project
  description: UnitedHealth Group implements Da Vinci IGs for payer data exchange including PDex Plan Net for provider directory
    and Drug Formulary IG.
artifacts:
  openapi:
  - name: UnitedHealth Group Optum API
    url: openapi/unitedhealth-optum-api-openapi.yml
  jsonSchema:
  - url: json-schema/optum-fhir-bundle-schema.json
  - url: json-schema/optum-fhir-patient-schema.json
  - url: json-schema/optum-fhir-explanation-of-benefit-schema.json
  - url: json-schema/optum-fhir-coverage-schema.json
  - url: json-schema/optum-fhir-practitioner-schema.json
  - url: json-schema/optum-fhir-medication-knowledge-schema.json
  jsonStructure:
  - url: json-structure/optum-fhir-bundle-structure.json
  - url: json-structure/optum-fhir-patient-structure.json
  - url: json-structure/optum-fhir-explanation-of-benefit-structure.json
  - url: json-structure/optum-fhir-coverage-structure.json
  - url: json-structure/optum-fhir-practitioner-structure.json
  - url: json-structure/optum-fhir-medication-knowledge-structure.json
  jsonLd:
  - url: json-ld/unitedhealth-optum-api-context.jsonld
  examples:
  - url: examples/optum-fhir-patient-example.json
  - url: examples/optum-fhir-bundle-example.json
  - url: examples/optum-fhir-coverage-example.json
  - url: examples/optum-fhir-practitioner-example.json
  - url: examples/optum-fhir-medication-knowledge-example.json
  spectralRules:
  - url: rules/unitedhealth-spectral-rules.yml
  capabilities:
    shared:
    - url: capabilities/shared/optum-api.yaml
    workflows:
    - url: capabilities/health-data-interoperability.yaml
  vocabulary:
  - url: vocabulary/unitedhealth-vocabulary.yaml
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com

UnitedHealth Group

APIs 4

Open Collections 1

GraphQL 1

Pricing Plans 1

Rate Limits 1

FinOps 1

Semantic Vocabularies 1

Spectral Rules 2

JSON Schema 6

JSON Structure 6

Examples 5

Security Posture 3

Agentic Access 1

Agent Surfaces 1

Access & Security 3

Company 1

Source (apis.yml)